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Combination antipsychotic therapy in clinical practice.
Andre Tapp1, Amanda Ernst Wood, Lori Secrest
1Department of Veterans Affairs Puget Sound Health Care System, Tacoma, Washington 98493, USA. tapp.andre@seattle.va.gov
Psychiatric Services (Washington, D.C.)
|January 2, 2003
Summary
Antipsychotic drug combinations are common, often used for persistent positive symptoms or medication switching. Further trials are needed to confirm clinical benefits and guide antipsychotic polypharmacy use.
Area of Science:
- Psychiatry
- Pharmacology
Background:
- Antipsychotic drug combinations are frequently prescribed in clinical practice.
- Expert recommendations generally position antipsychotic combinations as a last resort treatment option.
Purpose of the Study:
- To investigate the reasons behind the use of combination antipsychotic therapy in outpatient settings.
- To examine prescribing practices for antipsychotic combinations within the Department of Veterans Affairs Puget Sound Health System.
Main Methods:
- A retrospective review of antipsychotic prescribing practices was conducted over a six-month period (1998-1999).
- Data were collected on the concurrent use of atypical and conventional antipsychotic medications.
Main Results:
- Of 1,794 patients receiving antipsychotics, 715 (40%) received an atypical agent.
- Ninety-three patients (13%) on atypical antipsychotics received combination therapy for at least 30 days.
- Reasons for combination included treating positive symptoms (conventional added to atypical) or medication switching (atypical added to conventional), with some patients remaining on the combination.
Conclusions:
- Study findings confirm the frequent use of combination antipsychotic therapy.
- Prospective controlled trials are necessary to validate perceived clinical benefits and establish guidelines for antipsychotic polypharmacy.